Both PPI and Surgery Good for GERD Long Term

Health Care 1 Comment

With contemporary treatments for gastroesophageal reflux disease (GERD) — either medical with esomeprazole or surgical with a laparoscopic antireflux procedure — most patients remain in remission for five years, an exploratory randomized trial found.

In the LOTUS (Long-Term Usage of Esomeprazole vs Surgery for Treatment of Chronic GERD) study, remission rates at five years were 92% (95% CI 89 to 96) for patients on esomeprazole and 85% (95% CI 81 to 90, P=0.048) for those who had laparoscopic antireflux surgery, according to Jean-Paul Galmiche, MD, of Nantes University in France, and colleagues. There were 19 treatment failures in the medical treatment group and 33 failures in the surgical group, the investigators reported in the May 18 Journal of the American Medical Association. Few data are available comparing optimal proton pump inhibitor therapy with laparoscopic surgery for GERD. To address this gap, Galmiche and co-investigators enrolled 554 patients from 11 European academic centers, randomizing them to esomeprazole, 20 to 40 mg per day, or laparoscopic surgery by experts using standardized surgical techniques. All patients initially had a three-month trial of esomeprazole, and only responders were randomized. Starting dose for patients in the esomeprazole group was 20 mg per day. This could be increased to 40 mg and then to 20 mg twice daily if symptoms persisted, and if response still was inadequate the patient was deemed a treatment failure. Patients who underwent the surgery were classified as failures if they still required cid-suppressing medication or had symptoms requiring other medical treatment. They also were considered failures if they required more than one dilatation for esophageal stenosis, experienced dysphagia, or died.

At the conclusion of the study, there were no differences between the groups in epigastric pain, diarrhea, or severity of heartburn. Similar levels of heartburn and regurgitation were reported by the esomeprazole group through the five years, while these symptoms decreased in the surgery group. Mean scores on health-related quality of life scales improved in both groups, approaching scores reported for healthy individuals.Throughout the study, serious adverse events were seen in 24.1% of the esomeprazole group and 28.6% of the surgical group.

(Source: Medpage Today).

Dr KK Aggarwal
Editor in Chief